Development of the AOSpine Patient Reported Outcome Spine Trauma (AOSpine PROST): a universal disease-specific outcome instrument for individuals with traumatic spinal column injury

Abstract

Purpose To report on the multi-phase process used in developing the AOSpine Patient Reported Outcome Spine Trauma (AOSpine PROST), as well as the results of its application in a pilot study. Methods The International Classification of Functioning, Disability and Health (ICF) methodology was used as the basis for the development of this tool. Four preparatory studies and a consensus conference were performed, and resulted in the selection of 25 core ICF categories as well as the scale for use. The first draft of the Dutch version of AOSpine PROST was pilot tested among a consecutively selected representative sample of 25 spine trauma patients, using the 'think aloud' and 'probing' methods. Results Of the 25 core ICF categories, 9 related to body functions, 14 activities and participation, and 2 environmental factors. Those 25 core categories were implemented into the selected response scale, and resulted in a draft version of AOSpine PROST consisting of 19 items. From the pilot study, very satisfactory results were obtained for comprehensibility, relevance, acceptability, feasibility and completeness, as well as high internal consistency (Cronbach's a = 0.926). Conclusions Following the ICF methodology and including the results of 4 different preparatory studies and a consensus conference, the AOSpine PROST is developed. Taking the results from the subsequent pilot study into account, a definite version to be further validated will be developed. The AOSpine PROST has the potential to be a helpful tool in clinical practice and research to compare various treatments and improve the quality of health care.

Reliability and Validity of the English Version of the AOSpine PROST (Patient Reported Outcome Spine Trauma)

“…We found this to be a grounded decision as pretesting was already performed for the Dutch version in a previous study. 19 As hypothesized, patients had no misunderstanding of the questions and no question was indicated as inapplicable. Patients provided very useful information on the general concept of AOSpine PROST: it was questioned whether they should also take the trauma-related injuries into account when scoring an item.…”

“…17 18 Four preparatory studies, followed by an international consensus conference, led to the development of a Dutch version of AOSpine PROST. 19 In the developmental process of the AOSpine PROST we sought to focus on patients sustaining injuries to their spinal column and excluded completely paralyzed (ASIA impairment grade A or B at discharge from hospital) and polytrauma patients (Injury Severity Score [ISS] >15), to identify specific problems related to spine trauma. A validation study among traumatic spinal column injury patients in the Netherlands showed very good results.…”

Reliability, validity and responsiveness of the Dutch version of the AOSpine PROST (Patient Reported Outcome Spine Trauma)

“…Subsequently, a draft Dutch version of the tool was developed by clustering the 25 core ICF categories into 19 items and implementing those into the selected 0-100 Numeric Rating Scale (NRS-101). After pilot testing, a definitive Dutch version to be validated was developed [8] In the developmental process and initial validation, we sought to focus on patients sustaining injuries to their spinal column and excluded completely paralyzed and polytrauma patients, to identify specific problems related to spine trauma. This study aimed to validate the Dutch version of the AOSpine PROST among traumatic spinal column injury patients.…”

Development and reliability of the AOSpine CROST (Clinician Reported Outcome Spine Trauma): a tool to evaluate and predict outcomes from clinician’s perspective

“…We felt that this parameter would add a valuable contribution to the overall tool, and provide a direct connection to the patient's reported outcome as expressed by AOSpine PROST (Patient Reported Outcome Spine Trauma). This AOSpine PROST was developed and validated on the basis of different foundational studies and following an international consensus conference [25]. In general, fair to moderate results were observed for the inter-rater reliability of the tool, while the intra-rater reliability showed moderate to good results.…”